AUDIT AND REAUDIT OFREWRITING DEPOT PRESCRIPTION CARDS

IN TREATMENT TEAM IN FOLLY HALL, HUDDERSFIELD

BY DR CHINWE VIOLA UTOMI

CT2 PSYCHIATRY TRAINEE, OLD AGE INPATIENT

SOUTH WEST YORKSHIRE PARTNERSHIP NHS TRUST

SUPERVISED BY DR DOUGLAS

INTRODUCTION

• WHY THIS AUDIT?

• I carried out a retrospective study of cards re-

written between April and June 2020 in the

treatment team in Folly Hall in July 2020.

• To evaluate whether we were re-writing depot

cards according to Trust's guideline.

• The outcome was noted, recommendations were

made and followed.

• Then a re-audit was done in July 2021 using

cards re-written between April and June 2021.

TRUST GUIDELINES FOR PRESCRIBERS ON RE-WRITING DEPOT PRESCRIPTIONS

Is the dose within the BNF limit? If not, is there a high dose

antipsychotic form?

Has the patient had a set of bloods and ECG done as per

guideline?

Has the patient had a BMI check and set of observation recorded within the past year?

Has the patient been asked about side

effects?

Has the patient been reviewed by a medic in the past 1 year?

TABLE SHOWING SUMMARISED INVESTIGATION GUIDELINE

INVESTIGATION BASELINE 6 MONTHS 12 MONTHS ONGOING

Full blood count ** ** Annually

Urea & Electrolytes ** ** Annually

Liver function ** ** Annually

Thyroid function ** ** Annually

Prolactin ** ** ** Annually

Glucose/ HbA1c ** ** ** Annually

Lipid profile ** ** Annually

ECG ** ** Annually

SAMPLING METHOD

Cards were chosen randomly from the shelves and sorted by choosing cards re-written in the specified period of the audit.

Sample size of 40 prescription cards.

Same method was used for the re-audit.

In addition, cards were grouped into the Core team and Enhanced team.

DATA GATHERING

Prescription cards – Information retrieved includes Dose of antipsychotic and side effects chart

SystmOne- Last review by medics, BMI and observations record

ICE – Date of last blood result

RESULTAUDIT REAUDIT

DOSE 100% 100%

BLOOD RESULT 34 OUT OF 40

(85%)

40 OUT OF 40

(100%)

BMI AND OBS 100% 100%

SIDE EFFECTS 100% ON

SYSTEM1

100% ON

SYSTEM1

REVIEWED BY

MEDIC

34 OUT OF 40

(85%)

35 OUT OF 40

(87%)

ECG 26 OUT OF 40

(65%)

30 OUT OF 40

(75%)

GRAPHIC REPRESENTATION OF AUDIT AND REAUDIT RESULTS

0%

20%

40%

60%

80%

100%

120%

BLOOD RESULT BMI AND OBS SIDE EFFECTS REVIEWED BY MEDIC ECG

Chart Title

AUDIT REAUDIT Column1

RESULT INTERPRETATION

• The result showed an improvement across board as service users that had up

to date bloods moved from 80% to 100%, BMI/Obs check and side effect

charts remained at 100%, those that has been reviewed by a medic in the

last 1 year increased to 87%, while those that have had ECG done moved

from 65% to 75%.

RESULTS CONTINUED

• 24 Prescription cards from Core team

• 16 prescription cards from Enhanced team

RESULT CONTINUED

CORE TEAM ENHANCED TEAM

DOSE OF

MEDICATION

24 OUT OF 24

(100%)

16 OUT OF 16 (100%)

BLOOD RESULT 24 OUT OF 24

(100%)

16 OUT OF 16 (100%)

OBS AND BMI 24 OUT OF 24

(100%)

16 OUT OF 16 (100%)

SIDE EFFECT CHART 24 OUT OF 24

(100%)

16 OUT OF 16 (100%)

REVIEWED BY MEDIC 21 OUT OF 24

(87.5%)

14 OUT OF 16 (87.25%)

ECG 17 OUT OF 24 (70%) 13 OUT OF 16 (81%)

RECOMMENDATIONS FROM AUDIT

Report Audit result according to teams.

Redesign a reminder chart to paste in the treatment team (next slide is a sample of the reminder chart posted in the treatment team)

Liaise with the treatment team nurses on the best way to record side effects, and possibly blood result.

In addition, a reminder email was sent out.

GUIDELINES FOR REWRITING DEPOT CARDS

Are you about to rewrite Depot cards? Please check, fill the date and tick boxes

completed.

Is the dose of the antipsychotic

within the BNF limit? If not, is

there a high dose monitoring card

attached?

Are the bloods up to date?

Has the patient done a recent

ECG?

Are the Observations and BMI

recorded?

Have you looked at the side effect

chart?

Has the patient been reviewed by

a medic in the last one year?

Can you please record your

findings on systemone

RECOMMENDATIONS FROM REAUDIT

To continue using the reminder chart as it proved effective

For nursing staff to continue recording the due date for next set of bloods at the top corner of the prescription cards.

A similar audit can be carried out in other treatment teams

RECOMMENDATION

These were further recommendations after presentation-

To clarify if waist measurement is part of the guideline.

To clarify if patients turned up for annual review, as this may account for some of the lapses.

CONCLUSION

The full audit cycle of audit and reaudit has been completed with improvement seen in some aspects of the service provided. It is important to continue following the recommendations that produced these results.

The audit has also highlighted areas that needs further improvement. An audit may be carried out again to assess for further improvements.